For the first time, death and complication rates for individual surgeons are being made public. The new database, called Surgeon Scorecard, was released this week by ProPublica.
The researchers at ProPublica reviewed the Medicare billing records of more than 17,000 surgeons nationwide for death and complication rates related to eight common, elective low-risk procedures that were performed between 2009 and 2013. The procedures reviewed included knee replacements, hip replacements, three types of spinal fusions, gall bladder removals, prostate removals and prostate resections. Readmissions within 30 days in which the principal diagnostic code could indicate a potential complication from one of the eight procedures, were also considered. Two dozen physicians participated in the reviews.
In the interest of fairness, trauma and other high-risk cases were excluded from the review, as were surgeries on patients who were admitted via the emergency department or from another healthcare facility. Scores were adjusted for differences in patient health, age and hospital quality.
What ProPublica found is that even within "good" hospitals, surgeon performance can vary significantly. And half of all U.S. hospitals have surgeons with both low and high complication rates on their medical staffs.
Industry reactions
Debate over whether or not ProPublica's methodology was valid prompted the company to develop a forum to facilitate conversation among patient safety experts. Overall, the comments have been positive, but there are some exceptions.
"This is an exciting milestone towards ending medical harm because for the first time we are seeing that there is significant variation in the quality and safety outcomes of individual surgeons—a variation that can have devastating effects on surgical patients," Lisa McGiffert, Consumers Union Safe Patient Project, said. "These variations must be identified in order to prevent poor outcomes. ProPublica has taken a first big step toward that goal."
"I think the methodology was rigorous and conservative," said Dr. Thomas Lee, a professor at the Harvard School of Public Health. "I would be surprised if any experienced clinician challenged the basic finding, which is that there is real variation among surgeons. A critical step toward improving care is to recognize that there are opportunities to improve. I think transparency on quality is a powerful tool, and, frankly, I prefer that to financial incentives as a way to drive competition and improvement on quality."
Others were on the fence. Dr. Rocky Bilhartz, a cardiologist in College Station, Texas, told USA Today he is concerned that medical transparency will become a "witch hunt" as opposed to a helpful statistic. "But I think we are amiss if we think all doctors are equal, they're not," he said. "It's much like other professions in society. There are good people who can fix your car and those that can't. But my question is about the cause—and in my experience it's surgeons taking on the most complicated cases."
Dr. Peter Pronovost, Senior Vice President for Patient Safety and Quality and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, thinks the methodology used for the study was flawed. "The ProPublica measure is not valid," he said. "Though the methodology does account for some of the potential biases that might unjustly influence findings, it fails to account for another significant bias. For the ProPublica method to be a valid measure of surgical quality, all patients facing a potential readmission should have the same probability of being readmitted. Only then could readmission rates serve as a surrogate for complication rates and thus surgeon quality."